Patient Forms

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Click here to download

Medical History Form

View or print PDF in English

Patient Registration Form

View or print PDF in English

Acknowledgement of Receipt of Patients’ Rights and Advanced Directives

View or print PDF in English (Charlotte Gastroenterology & Hepatology)
View or print PDF in English (Endoscopy Center of Lake Norman)

Patient Satisfaction Survey (Endoscopy Division)

Fill out form online

Patient Satisfaction Survey (Medical Group)

Fill out form online

Patient Rights

View or print PDF in English

Notice of Privacy Practices

View or print PDF in English (Charlotte Gastroenterology & Hepatology)
View or print PDF in English (Endoscopy Center of Lake Norman)

Open Access Colonoscopy Program Medical Questionnaire

Fill out form online

Colonoscopy Consent Form

View or print PDF in
English
Español
Vietnamese

Conscious Sedation Consent Form

View or print PDF in
English
Español
Vietnamese

Upper Endoscopy Consent Form

View or print PDF in
English
Español
Vietnamese

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